Reconstruction techniques are varied using various resources. They may also be performed, basically, in a single surgical time or in more than one. The indication for the different techniques has to do with treatment surgery performed, with the breast volume, with the patient's biotype, with any other pathologies that the patient may suffer and, if there are several options, with the personal choice.
In the vast majority of cases the reconstructive techniques are performed in a single time, that is during the mastectomy, involving the use of the patient's own tissues, which are mobilized by immediately restoring the breast volume. One example would be the use of excess tissue from the abdominal wall, the common "tire". Sometimes, when the patient's tissue is insufficient, a small prosthesis can be used at the same time.
When, because the patient is thin, is a smoker, is diabetic among other reasons, it is not possible to use a technique mobilizing own tissues using a technique in two times. The first time the reconstruction is performed at the same time as the mastectomy.
At that time an expander is placed. An expander is a kind of bag with a valve that is filled with serum. This progressive increase in volume will force the tissues to grow, just like the growth of a pregnant woman's belly. When the volume obtained is the appropriate one can proceed to the second time. At this point the expander is replaced by a prosthesis and small adjustments are made judged necessary.
In both the immediate reconstruction and the two-stage reconstruction techniques, it may be necessary to intervene in the contralateral breast so that both are similar. In both techniques the reconstruction of the aorta-nipple complex is performed some time after the placement of the own tissue or the prosthesis. They should acquire their definitive position so that the aorta-nipple complex can be reconstructed in alignment with the contralateral. This reconstruction can be performed using the skin of the patient for total reconstruction or using skin in the reconstruction of the nipple and tattooing the areola.
When the surgery to be performed preserves the breast, called conservative surgery, it may be necessary, also here, to use techniques that preserve the cosmetic aspect of the operated breast. These techniques can range from small mobilizations of the tissue of the breast operated to the use of the patient's own tissues to fill some defects of volume.
We may have to use techniques of greater mobilization of the tissues of the operated breast, in which case it is necessary to intervene on the other to symmetry. All these processes necessarily involve a very frank and enlightening conversation between the patient and the surgical team that will treat it, so that the therapeutic and reconstructive goals for all meet.
To discuss these topics in depth, please join the Encounters on the "Challenges of Young Women with Breast Cancer" promoted by the CUF Breast Unit. Find the dates of the meetings on here.
An article by Dr. Luis Mestre, surgeon and coordinator of the Breast Unit at Hospital Infante Santo CUF.